MDNews - Minnesota

Q With the physician shortage intensifying, the role of nonphysician providers is expected to continue growing. What is the university of minnesota's role in training future advanced practice providers? How do you use these providers in your practice? Wilson: We are very much growing our numbers of midlevels, as well as the activities these professionals can perform. I use the term 'midlevels' broadly to include advance practice nurses, physician assistants, clinical nurse specialists and pharmacists. The advantages to me are that we put patients in the center of all we do. In redesigning healthcare models — both on the educational side and in practice — it makes sense for patients to benefit from the expertise of all these different providers. Q What are the most significant fiscal challenges you — and healthcare organizations in general — expect to face during the next 12 months? Dr. Daniels: I think we need to provide outstanding patient-centered care that has exceptional value. That means providing even better outcomes at an even more efficient price. To do this, we have to develop or perfect operational systems that maximize the use of every health professional's time, while still meeting the needs of our patients. To bring those two aims together, we need to develop innovative approaches and be prepared to deliver health care in novel ways, whether via the Internet or through increased efforts to teach patients how to manage their own care. Q from an investment standpoint, how do you balance patient expectations about amenities with needs such as leading-edge technology and facility expansions? Wilson: I have to chuckle because I think about this every day. We think about all our investments in total and make really tough choices. Dr. Daniels: We try to attack patient amenities and facilities/equipment purchases at the same time. For example, we are in the process of building a 300,000-square-foot ambulatory center. We will maximize the efficiency of the center with extended hours. That will enhance the patient experience and allow us to invest in leading-edge technology. We are not doing things the same way now we have always done; instead, we are finding efficiencies that will give us the capital to invest as we want to. It is a precarious balance. Q What is the most significant obstacle to applying clinical research at the bedside in 2014? How are you overcoming this obstacle? Dr. Daniels: It can be hard to enroll patients in relevant clinical trials. We have to provide the infrastructure so it is easy for patients to agree to participate in clinical trials and easy for physicians to enroll and manage patients in those trials. We do that by integrating clinical research into the care we deliver; we have shining examples in our bone marrow transplant program, organ transplant programs and cardiovascular program. Wilson: The most significant obstacle today is that research — and its clinical application — is considered a specific role; we organize things so a certain person, such as a research nurse, is responsible for obtaining patient consent, for example. This is an expensive model and results in limited buy-in from the non-research members of the team. I believe that embedding research roles into the clinical staff would improve matters. As nurses, pharmacists and social workers — not just physicians — we chose an academic medical center to work for because we value the missions of teaching and research as well as clinical practice. We can integrate these missions into one role. I want our nurses to see themselves as working for an academic medical center, and the same goes for pharmacists and others on our patient care teams. When 6,000 people participate in research, it's a larger work force and will ultimately benefit the patient. Q As science evolves, particularly as relates to stem cell research, how will the patient's role in clinical trials change, if at all? Dr. Daniels: We perform stem cell research here with incredible results. Our experience shows that patients are enthusiastic supporters. Stem cell research provides treatments for conditions that otherwise would have been untreatable. Wilson: Patients' roles in clinical trials will continue to evolve. I believe patients will proactively become involved in banking samples. Instead of signing up for a clinical trial and knowing exactly what a specimen will be used for, patients will be able to consent not knowing what trial their blood will be designated for. They will be interested in consenting to have their blood banked for future utilization, so their role will become more prospective than it has been. ■ ABouT DR. DANiElS BoBBi daNielS, Md, right, nephrologist, attended medical school at the University of Washington School of Medicine. She is Vice-Dean for Clinical Affairs and Professor of Medicine at the University of Minnesota Medical School. ABouT CARolyN WilSoN CarolYN wilSoN, rN, left, attended nursing school at Rush Medical University. She received a Master of Business Administration from Benedictine University. Wilson served as Chief Operating Officer at the University of Chicago Medical Center for 13 years. MdNewS.CoM ■ MD News Twin Cities | 17

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